A breast cancer risk evaluation initiative for women aged 25–39 years: Implementation of the Tyrer–Cuzick model during well-woman gynecology visits

BACKGROUND: National organizations recommend formal breast cancer risk evaluation (BCRE) beginning at age 25 years; however, implementation remains inconsistent in routine clinical practice. Because BCRE frequently occurs during screening mammography visits beginning at the age of 40 years for average-risk women, younger women often remain outside established screening pathways. Gynecology practices offer an opportunity for earlier risk identification. LOCAL PROBLEM: Within the initiative's catchment area, high-risk breast cancer evaluations historically occurred at a median age of 48 years, with few women younger than 40 years receiving formal risk evaluation. METHODS: This quality improvement initiative used a pre- to post-implementation design in an outpatient gynecology practice. Women aged 25-39 years presenting for routine well-woman visits were included. The Tyrer-Cuzick model was integrated into the intake workflow, and certified medical assistants received education on breast cancer risk factors, model use, and management of high-risk results. INTERVENTIONS: A standardized workflow was developed in which BCRE was completed during patient intake before provider evaluation, allowing timely review and referral planning for high-risk patients. RESULTS: Breast cancer risk evaluation was completed for 65% (n = 77) of eligible patients. Among assessed women, 14% (n = 11) were identified as high risk (≥20% lifetime risk), and all were referred for further high-risk breast cancer evaluation. Staff reported strong feasibility and acceptability of workflow integration. CONCLUSION: Integrating the Tyrer-Cuzick model into routine gynecologic care represents a practical and scalable strategy for improving early identification of high-risk women and supporting nurse practitioner-led preventive breast cancer care.